On Thursday, May 14, 2020, Senator Elizabeth Warren (D-Mass) and Representative Andy Levin (D-Mich) introduced the Coronavirus Containment Corps Act. The Coronavirus Containment Corps Act was co-sponsored by Sens. Tina Smith (D-Minn.) and Jeff Merkley (D-Ore.).The legislation would establish a federal coronavirus contact tracing program.  Sen. Warren and Rep. Levin would like the legislation to be incorporated into any future coronavirus relief packages.

The bill would require the Center for Disease Control (CDC) to develop a national strategy for coronavirus contact tracing within 21 days after coordinating with state, local, and Tribal health officials. The bill would require the Director of the CDC to coordinate with the Director of the Indian Health Service (IHS) to ensure the contact tracing needs of Indian Tribes are met. The legislation would provide states and Tribes with $10 billion for hiring contact tracers and other staff. It would also provide states and Tribes with $500 million to find those who have lost their jobs during the coronavirus and prioritize their hiring as contact tracers. In addition, the legislation will ensure patient privacy by requiring the CDC to anonymize data, automatically delete patient data, and prohibit data-sharing within the federal government except within the CDC and IHS. Tribal health data sovereignty would also be protected by the proposed legislation.

The bill also provides grants to Indian Tribes, Tribal organizations, Alaska Native entities, Indian controlled organizations serving Indians, Urban Indian organizations, or Native Hawaiian organizations. The purpose of these grants will bethe recruitment, placement, and training of individuals seeking employment in contact tracing and related positions.

Contact tracing will help mitigate the transmission of COVID-19 by identifying all individuals who have been in contact with someone who tested positive with coronavirus. These potentially infected individuals are then tested for coronavirus and encouraged to quarantine if they test positive.

The Coronavirus Containment Corps Act would be a significant step forward in ensuring the health of the American Indian/Alaska Native (AI/AN) Population during this pandemic. The legislation also helpsUrban Indian Organizationsby making them eligible for grants to promote job opportunities for Urban Indians as contact tracers.

• Read More
• Statement From Senator Warren’s Office
• Coronavirus Containment Corps Act Text

On April 30, 2020, at President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) issued a second round of regulatory waivers and rule changes “to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.”

Many of CMS’s temporary changes will apply immediately for the duration of the Public Health Emergency declaration. The changes build on an array of temporary regulatory waivers and new rules CMS announced on March 30 and April 10. Providers and states do not need to apply for the blanket waivers and can begin using the flexibilities immediately. CMS also is requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities. Below are the blanket waivers issued separated into categories:

• New rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries:

  • Under the new waivers and rule changes, Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. A written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.
  • Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law. With these changes, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements.
  • CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives.
  • CMS is announcing that Medicare and Medicaid are covering certain serology (antibody) tests. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.

• Additional highlights of the waivers and rule changes announced today:

  • CMS is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. For example, teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education. Inpatient psychiatric facilities and inpatient rehabilitation facilities can admit more patients to alleviate pressure on acute-care hospital bed capacity without facing reduced teaching status payments. Similarly, hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments.
  • Under current law, most provider-based hospital outpatient departments that relocate off-campus are paid at lower rates under the Physician Fee Schedule, rather than the Outpatient Prospective Payment System (OPPS). CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS.
  • Long-term acute-care hospitals can now accept any acute-care hospital patients and be paid at a higher Medicare payment rate, as mandated by the CARES Act.

• Healthcare Workforce Augmentation:

  • Beneficiaries may need in-home services during the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, as mandated by the CARES Act. These practitioners can now (1) order home health services; (2) establish and periodically review a plan of care for home health patients; and (3) certify and re-certify that the patient is eligible for home health services
  • CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings.
  • CMS is waiving a requirement for ambulatory surgery centers to periodically reappraise medical staff privileges during the COVID-19 emergency declaration

• Prioritizing Hospitalization Services:

  • CMS is allowing payment for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patients’ homes.
  • CMS is temporarily allowing Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in the safety of their homes. Previously, clients had to travel to a clinic to get these intensive services.

• Expansion of Telehealth in Medicare:

  • CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.
  • Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department of the hospital.
  • Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.
  • CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of $14-$41 to $46-$110. The payments are retroactive to March 1, 2020.
  • As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.
  • CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.

• In addition, CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs):

  • ACOs are groups of doctors, hospitals, and other healthcare providers, that come together voluntarily to give coordinated high-quality care to their Medicare patients. CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.
  • CMS is permitting states operating a Basic Health Program (BHP) to submit revised BHP Blueprints for temporary changes tied to the COVID-19 public health emergency that are not restrictive and could be effective retroactive to the first day of the COVID-19 public health emergency declaration.

In response to these changes Seema Verma, CMS Administrator, stated that “CMS’s changes will make getting tested easier” and the health care system “more accessible for Medicare and Medicaid beneficiaries.”

https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

https://rubengallego.house.gov/media-center/press-releases/icymi-reps-gallego-mullin-introduce-bill-boosting-resources-urban-indian

April 20, 2020
Press Release

WASHINGTON, DC – Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK) introduced H.R. 6535 last week to expand Federal Tort Claims Act (FTCA) coverage to urban Indian health organizations, giving them a desperately needed boost in resources as they suffer shortages, closures, and financial hardship as a result of the COVID-19 pandemic.

The Indian Health System, commonly referred to as the ITU system, is made up of the Indian Health Service (IHS), Tribal health programs, and urban Indian organizations (UIOs). UIOs provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers. H.R. 6535 would create parity within the ITU system by extending FTCA coverage to urban Indian organizations, who currently are forced to divert resources away from health care in order to foot exorbitant liability costs themselves.

“Urban Indian organizations, including Native Heath in my District, are on the front lines of this pandemic. Individual facilities are reporting skyrocketing costs in the hundreds of thousands and dangerous supply shortages. Three UIOs have already closed their doors as a result of the strain,” said Rep. Gallego, Chair of the Subcommittee for Indigenous Peoples. “We cannot afford to leave urban Indians without access to care during this public health crisis. My bill will both bring long overdue parity to urban Indian health providers and provide an infusion of desperate resources to an urban Indian health system on the brink.”

“Urban Indian Health Centers play a critical role in providing health care to Native Americans. Our bill ensures they are covered by the FTCA so that they won’t have to use their limited resources to cover costly liability bills. I want to thank Congressman Gallego for working with me on this legislation that will improve health care for Native Americans,” said Rep. Mullin.

The National Council for Urban Indian Health (NCUIH) said: We are extremely grateful for Congressman Gallego and Congressman Mullin’s leadership in introducing this legislation for a long-needed fix to the medical malpractice liability protection to ensure parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, which could be spent providing health care for the American Indians and Alaska Natives. As all other Indian Health Care Providers are covered by FTCA and it is extended to Community Health Centers as well as volunteers, this legislative fix is needed now more than ever to ensure continuity of health care in a time when it’s needed most.

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APRIL 9, 2020 | CLIP OF VICTORIA KITCHEYAN ON NATIVE AMERICAN COMMUNITIES AND CORONAVIRUS

• Victoria Kitcheyan, Chair, National Indian Health Board
• John McArdle, Host, C-SPAN

Clip Transcript

Call from: Michigan

Thank you so much for taking my call. I run an urban agency an urban indian center just south of Detroit called the American indian Services. We’re a mental health provider as well as a food provider. My question is, what is being done for the 75% of American Indians who live in cities? We’ve had a hard enough time just surviving because the State of Michigan has cut our budget repeatedly for the last 5 years. We’re trying to hang on and serve the American Indians in the cities. If people went home, the tribes would not be able to accommodate them. They would be bankrupt in weeks, so what’s going to be done for the Indian people living in the cities?

Victoria Kitcheyan

Thank you Faith for that question. The urban Indian organization, NCUIH, has been a champion in advocating for urban organizations and they were also included in the first funding package and, in fact, the urban indian priorities are something that cannot be forgotten because many of our tribal members live in urban areas and most recently the National Congress of American Indians and the National Indian Health Board signed on to a letter today advocating for the needs of the fourth funding package and in there the urban needs have also been advocated for. So, I understand your frustration and often the urbans are left out and so the federal agencies have to consult with the federally recognized tribes and they only have to concur with the urban organizations, but we cannot forget our relatives that are living in some of these most highly populated areas that need the resources just as much as we do on the reservation.